To investigate the effects of respiratory distress syndrome (RDS) on the neurobehavioral function of premature infants, 26 infants of ≤32 weeks gestation were evaluated by a modification of the Brazelton Neonatal Scale within the first four days of life. 17 were infants with uncomplicated prematurity (PBLCs). 9 had RDS, uncomplicated by depression at birth, sepsis, seizures, hyperbilirubinemia, or intracranial hemorrhage. When examined, 3 were on respirators and 3 had nasal prongs in place. Infants with RDS showed decreased ability to adapt to repeated stimuli and to attend to and orient toward light, sound, face, and voice, compared to PBLCs. Infants with RDS were also less alert. A higher level of irritability and a higher peak of arousal were noted in infants with RDS. The two groups did not differ in level of activity or in response to a cloth on the face. Grasp reflexes were diminished in infants with RDS, but Moro and deep tendon reflexes were not. Resting muscle tone was similar in the two groups. Since in our study tone, reflexes, and activity were not affected by even severe uncomplicated RDS, the development of hypotonia, hyporeflexia, or hypoactivlty in an infant with RDS therefore points toward a complication such as sepsis or intracranial hemorrhage. However, our results suggest that cortical functions such as adaptation, orientation, and alertness are impaired in infants with RDS.